Provider Demographics
NPI:1629113816
Name:PREMIER ENDODONTICS PC
Entity Type:Organization
Organization Name:PREMIER ENDODONTICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:L
Authorized Official - Last Name:SYKES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:803-419-1327
Mailing Address - Street 1:7024 BROOKFIELD RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-2211
Mailing Address - Country:US
Mailing Address - Phone:803-419-1327
Mailing Address - Fax:803-419-2974
Practice Address - Street 1:7024 BROOKFIELD RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-2211
Practice Address - Country:US
Practice Address - Phone:803-419-1327
Practice Address - Fax:803-419-2974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC31901223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty